CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 142 205.250000 7594.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 90 51.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 71 199.000000 7363.0000 37.0000
Subtotal (Total Children Is Unduplicated) 166 455.250000 14957.2500 32.8550
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 36.000000 2549.5000 70.8194
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 10.500000 619.1800 58.9695
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 9.000000 637.5000 70.8333
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 44.000000 2442.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 40.000000 3000.0000 75.0000
Subtotal (Total Children Is Unduplicated) 60 139.500000 9248.1800 66.2952
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EI Services,Class #03
INTR-T1013-INTERPRETER 13 19.250000 962.5000 50.0000
Subtotal (Total Children Is Unduplicated) 13 19.250000 962.5000 50.0000
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Total 614.000000 25167.9300 40.9901
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Number of Children (Unduplicated) With at Least One Service 171
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Center 09
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 576 601.000000 24230.4300 24230.4300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 2.000000 112.5000 37.5000
8 11.000000 825.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 585 614.000000 25167.9300 24267.9300